BUN-albumin ratio as a prognostic marker in decompensated heart failure with reduced ejection fraction

Decompensated heart failure with reduced ejection fraction (D-HFrEF) is a prevalent cause of hospitalization and mortality. Early risk stratification is crucial for targeted interventions. The blood urea nitrogen to serum albumin ratio (BAR) has shown prognostic value in critical illness, but its role in D-HFrEF is understudied.

This study aimed to evaluate the association of BAR calculated within 24 h of admission with length of hospital stay (LOS), in-hospital mortality, and 30-day readmissions in patients hospitalized with D-HFrEF and identify an optimal cut-off value for each outcome.

This was a multicenter retrospective cohort analysis of 2286 patients hospitalized in 2022 with D-HFrEF. The population's median age was 72.00 years, with 59.8 % being male. In the fully adjusted model, each one-unit increase in baseline BAR was associated with a 2.85 % increase in the length of hospital stay in days (IRR: 1.027, 95 % CI: 1.021-1.033, p < 0.001) and significantly higher odds of in-hospital mortality (OR: 1.107, 95 % CI: 1.076-1.139, p < 0.001) and prolonged LOS (≥30 days) (OR: 1.065, 95 % CI: 1.034-1.097, p < 0.001). BAR was not significantly associated with 30-day readmission (p = 0.06). Receiver operating characteristic analysis identified optimal BAR cut-off points of 6.82 for mortality.

Our data show that an elevated BAR on admission is associated with increased in-hospital mortality and LOS > 30 days in patients hospitalized for D-HFrEF. This readily available marker can aid in identifying patients at higher risk for adverse events. Prospective studies are needed to validate our findings.